The relationship between cardiovascular stress reactivity and carotid artery intima-media thickness (IMT) has been established in adults, but not yet studied in children. Cardiovascular reactivity to an ad lib speech was measured in 20 boys and 20 girls age 11.0 +/- 1.4 years. Measures included heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure reactivity, and mean common carotid artery IMT. Sequential regression analyses were used to establish the incremental increase in R(2) for the prediction of IMT due to cardiovascular reactivity independent of age, socioeconomic status, race, percentage body fat, and baseline BP or HR. SBP reactivity (beta=0.002, , p<.05), but not DBP reactivity (p=.12) or HR reactivity (p=.82), independently predicted carotid artery IMT. This study provides initial evidence that SBP reactivity is associated with IMT and perhaps the early pathogenesis of cardiovascular disease in childhood.